Food insecurity is widespread throughout Senegal, West Africa and is a major contributing factor to malnutrition. Malnutrition is associated with poor HIV outcomes and an increased risk of death among HIV- positive patients starting antiretroviral therapy (ART). However, HIV, malnutrition and food insecurity interact through reciprocal relationships. Differentiating malnutrition due to untreated and/or poorly controlled HIV disease from malnutrition due to food insecurity would provide a powerful opportunity to target individuals in need of additional interventions and to integrate these interventions into HI programs. Food insecurity additionally contributes to poor HIV outcomes through mechanisms that are not mediated by malnutrition. Food insecurity is associated with decreased ART adherence. This has the potential to lead to increased virologic failure, antiretroviral (ARV) resistance, and HIV transmission. Despite the WHO recommendation that as an urgent priority, focused evidence-based nutrition interventions should be part of all national AIDS control and treatment programs, only a minority of countries in sub-Saharan Africa have incorporated nutritional strategies into HIV treatment programs. This is partially due to a lack of evidence regarding which specific interventions would be most appropriate and effective. There are significant gaps in our understanding of the relationships between HIV, malnutrition, and food insecurity. These gaps represent critical barriers to progress in the field of HIV management, treatment, and prevention in resource limited settings. For this K23 Career Development Award, the PI will build expertise in the relationships between HIV, malnutrition, and food insecurity. She will conduct a prospective longitudinal study of HIV positive children and adults initiating ART in Senegal with a focus on how food insecurity and malnutrition affect HIV outcomes. She will determine and quantify the association between food insecurity and malnutrition and HIV outcomes in both children and adults for 12 months after ART initiation (Aim 1), determine the association between food insecurity, household nutritional status and HIV outcomes in both children and adults for 12 months after ART initiation (Aim 2), and determine the feasibility of integrating specific nutritional interventions into HIV programs in Senegal (Aim 3). During the 5 year K Award period she will strengthen her skills in the use of advanced epidemiological methods and develop expertise in implementation science and impact evaluation. She has assembled a multidisciplinary team of globally recognized experts to guide her career development and provide mentorship. After the completion of the 5 year K Award period, she will use the skills and expertise acquired through her Career Development Plan to design and conduct a clinical trial to compare nutritional interventions to improve HIV outcomes in Senegal. She will then work with interagency collaborators to integrate nutritional interventions into HIV programs in Senegal and West Africa.